Marvin L. Adland

Use of couples therapy groups in conjunction with lithium in the long-term management of married manic-depressive patients is described. Among bipolar patients on lithium, those in couples group therapy had more benign posthospital course than those given minimal support beyond medication. The structure and benefits of the couples group are discussed.

Despite the monumental follow-up studies of patients with manic-depressive illness by Lundquist (1945), Rennie (1942), Hastings (1958), and more recently, Shobe (1971), the development of the concept of unipolar and bipolar forms of affective disorders with clinical (Brodie and Leff, 1971), genetic (Dunner et al., 1970; Winokur et al., 1969), and biologic differences (Buchsbaum et al., 1971; Cohn et al., 1970), has necessitated a revaluation of the question of outcome in this psychiatric illness. The availability of lithium carbonate for both acute and prophylactic treatment of mania (Schou, 1968; Coppen et al., 1971), and possibly depression (Goodwin et al., 1972), has also increased the clinical importance of the unipolar-bipolar distinction. The purpose of this study is to provide further information regarding the course of bipolar manic-depressive illness by reporting the level of functioning, recurrence of episodes, and quality of life at follow-up assessed in a group of patients formerly hospitalized for mania at the National Institutes of Health.

Nurturing attitudes and behaviors among seven married couples, each of which contained one partner who had manic-depressive illness, and their young children were compared with those of normal control families. Mothers from index families, in contrast to control mothers, were less attentive to their children's health needs, emphasized performance in some achievement-related areas, were more overprotective, and reported more negative affect toward the child. They also were more disorganized, less active with their children, and more unhappy, tense, and ineffective. Index parents secured lower scores in the areas of family interaction and social adjustment, and they experienced situational problems of considerable severity, including clinical depression in the well parent.